Medicare Compliance Specialist (Dublin, Ohio or Irving, Texas)

Medicare Compliance SpecialistHelp us deliver better health and healthcare through technology, innovation, and dedication.Medco is a leading healthcare company serving more than 60 million people. We're looking for individuals who are ready to challenge conventional wisdom in the spirit of positively impacting people's lives. Join the company that Fortune magazine ranked No. 1 in 'Most Admired Companies' in the pharmacy category and No. 5 globally in Innovation. Then, use your intelligence, creativity, integrity, and hard work to help us enhance our products and services. We offer a highly competitive base salary and an outstanding benefits program, including medical, prescription drug, dental, vision, 401(k) with Company match, life insurance, paid time off, tuition assistance, and an employee stock purchase plan.This Medicare Compliance Specialist is responsible for:-Operational adherence to CMS requirements and guidelines for Medicare D Coverage Determinations, Exceptions, and Appeals processing - monitoring internal processes and standard operating procedures (SOP). -Responsibility for auditing supporting operational areas, as well as, participating in CMS, Client and Internal Audits.-Audit compliance of Medicare D operations. Develop, publish and maintain audit results; provide summaries and/or present findings as required.-Perform monthly self-assessments for Product Team, CMS and Clients. Develop and manage reporting of results; follow up to confirm status and document remediation activity. Escalate outstanding issues as appropriate.-Review CMS Prescription Drug Plan Manuals and other internal publications to ensure the operational documentation meets Medicare D audit requirements.-Review weekly CMS directives to ensure all applicable SOPs, job aids and related material are updated to compliance for operational areas supporting Medicare.-Documents and communicates research protocols. Recommends improvements to existing training materials, quality processes and help files.-Manages resolution and workflow of CMS and Product Team inquiries. Ensures inquiries are thoroughly resolved within turn-around requirements through proactive follow up, discussion and documentation of resolution.-Documents Corrective Action Requests and Corrective Action Plans; tracks and monitors issues requiring escalation. -Submits suggestions for improvements to workflow, call flow and systems to enhance compliance.-Participates on project teams, work groups and related conference calls as needed.-Ensures audit, compliance and legislative requirements are adhered to and appropriate systems and controls are implemented as needed.-Performs other special projects, related duties and responsibilities as assigned.This position may sit in Dublin, OH or Irving, TX.

Requirements:
We are an Equal Opportunity Employer, M/F/D/VQUALIFICATIONS:- Bachelor?s Degree (or high school diploma with equivalent experience) -Operational experience with Medicare, preferably in a high volume processing environment.-Experience with coverage determination (prior authorization) and/or appeals processing.-Ability to maintain confidentiality and appropriately handle sensitive information with tact and discretion.-Experience leading cross-functional initiatives and projects.-Strong assessment capabilities; high degree of decision making skills. Solid analytical and problem solving abilities. -Demonstrated ability to perform data analysis, develop related recommendations and implement outcomes. -Strong verbal and written communication abilities; effective interpersonal skills. -Solid meeting facilitation skills and demonstrated ability to communicate effectively in an audit environment.-Demonstrated ability to influence and develop relationships at all levels of the organization. High degree of professionalism.-Effective coaching skills; ability to drive results and achieve objectives through others.-Strong sense of urgency;